Get the free Infant Hearing Screening Form and Instructions - City of Toronto

Infant Hearing Screening Form Discharge Screen Location. D I agree to have the information captured on this form shared with interpersonal health information on this form is collected in accordance

How to fill out infant hearing screening form

How to fill out infant hearing screening form

1. Obtain the infant hearing screening form from the appropriate healthcare provider or institution.
2. Fill in the personal details of the infant, including name, date of birth, and gender.
3. Provide the contact information of the parent or guardian, including name, address, phone number, and email.
4. Record any relevant medical history or information about the infant's hearing health.
5. Specify the date of the hearing screening and the healthcare professional who performed the screening.
6. Indicate the results of the hearing screening, including whether the infant passed or requires further evaluation.
7. If further evaluation is needed, provide details about the recommended follow-up or referrals.
8. Sign and date the form to verify the accuracy of the information provided.
9. Submit the completed form to the appropriate healthcare provider or institution.

Who needs infant hearing screening form?

1. Infant hearing screening form is needed for infants who require a hearing evaluation.
2. This includes newborns and young children who may be at risk for hearing loss due to various factors, such as premature birth, family history of hearing loss, certain medical conditions, or exposure to high levels of noise or ototoxic medications.

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What is infant hearing screening form?

Infant hearing screening form is a form used to assess the hearing ability of newborn babies.

Who is required to file infant hearing screening form?

Healthcare providers and hospitals are required to file infant hearing screening form.

How to fill out infant hearing screening form?

Infant hearing screening form can be filled out by recording the results of hearing tests conducted on newborn babies.

What is the purpose of infant hearing screening form?

The purpose of infant hearing screening form is to detect and address any hearing issues in newborn babies at an early stage.

What information must be reported on infant hearing screening form?

Information such as the date of birth of the baby, results of hearing tests, and any recommendations for further evaluation must be reported on infant hearing screening form.